Like them or not, guns are as American as covered wagons and the infield-fly rule. The revolutionaries and pioneers who forged the nation and peopled its wilderness really did cling to their guns as tenaciously as they clung to their religion. And while modern cosmopolitans may be shocked by the gun violence in this country — the worst among wealthy nations by far — well, that's an American tradition too.
Gun control is not. The mayhem in Tucson has revived a debate over America's gun culture that resurfaces every time some lunatic overexercises his right to bear arms. How could Jared Loughner be considered too dangerous to attend community college but not too dangerous to buy a Glock? Why are we allowed to pack heat at a Safeway when we can't pack shampoo in our carry-ons? Does the Second Amendment really protect our right to a magazine that holds 30 bullets? It's a necessary debate, but in the political arena, at least, the results are consistently lopsided. As National Rifle Association executive vice president Wayne LaPierre proclaimed two years ago, the guys with the guns make the rules. (See pictures of gun culture in America.)
Arizona, with its Old West heritage, has been at the forefront of the gun-rights movement. Last year, it passed a law making it the third state — after predominantly rural Vermont and Alaska — to allow citizens to carry concealed weapons without a permit. Another law allows Arizonans to carry guns in bars, as long as they're not drinking. The vast majority of the state's politicians — including Loughner's primary target, Congresswoman Gabrielle Giffords, a Democrat and gun owner — are strong Second Amendment supporters. Congressman Trent Franks, a Republican and gun owner, points out that Arizona has a much lower gun-violence rate than Washington, D.C., which has much more restrictive gun laws. "Criminals always prefer unarmed victims," Franks says. There have been no reports out of Arizona of any credible push for new gun restrictions; in fact, several reports show citizens are flocking to gun shops to increase their firepower. (See pictures of politicians and their guns.)
Unfortunately, the gun-rights vision of well-armed citizens shooting down an outlaw like Loughner midrampage did not come true in this case. Nationally, less than 1% of all gun deaths involve self-defense; the rest are homicides, suicides and accidents. In a study of 23 high-income countries, the U.S. had 80% of the gun deaths, along with a gun homicide rate nearly 20 times higher than the rest of the sample. Still, the gun-control movement has gotten little political traction outside selected major cities, and all but three states have laws that invalidate local gun restrictions. According to the NRA, 25 states have adopted "your home is your castle" laws that give homeowners wide latitude to shoot people on their property without fear of prosecution, and only 10 states prohibit or severely restrict the carrying of firearms in public. (Read "Why Are the Mentally Still Bearing Arms?")
In recent years, despite periodic spasms of attention after mass killings like those at Columbine and Virginia Tech, gun control has made no headway at the federal level either. It's telling that a progressive Chicago Democrat like President Obama — a longtime gun-control advocate whose election inspired fervent warnings about Big Government's confiscating firearms — has carefully avoided the topic in the White House. He even signed two laws that included provisions expanding gun access, one in national parks and one on Amtrak trains. If he objected to the provisions, he kept his objections to himself. A Brady Campaign to Prevent Gun Violence report gave Obama an F for leadership on gun control. "We haven't seen a lot of political courage on this issue," says Brady Campaign president Paul Helmke, a former Republican mayor of Fort Wayne, Ind. "Republicans march in lockstep with the NRA, and Democrats are scared to death."
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Wednesday, January 19, 2011
The Troubled Life of Jared Loughner
Navigating the cluttered corridors of Jared Loughner's mind will take psychiatrists months or years. We will likely never know all the reasons he took a cab to that Safeway on Jan. 8, paid with a $20 bill, calmly got his change and then killed six people and wounded 14 others.
But snapshots of his life are accumulating from acquaintances and his few friends. (His parents issued a short statement of apology, but they are said to be too distraught to speak about their son.) These snapshots depict a quiet, normal boy who had grown into a man descending steadily into serious mental illness. A partisan, highly nonscientific debate has erupted over whether extreme right-wing rhetoric could have inflamed whatever illness he may have and caused him to target Democratic Representative Gabrielle Giffords. We don't know the answer, but psychological research suggests that political rhetoric could never be the single cause that leads a person with complex mental problems to commit violence. (See pictures from a grieving Tucson.)
Case History
Pinpointing the precise moment a mental illness takes root is guesswork at best. As a young man, Loughner seemed ordinary enough — occasionally withdrawn, as all teens can be, and a little nerdy. He loved music and played the sax well. A classmate who had known him since elementary school, Ashley Buysman, says that when she heard the charges against him, "it just blew my mind."
But a darkness began massing around Loughner sometime after he dropped out of Mountain View High School in Tucson, Ariz., before his senior year. He started drinking a lot, according to Kylie Smith, who had known him since preschool. She lost contact with him between 2006 and 2008 and was stunned by how much he had changed. "He seemed out of it, like he was somewhere else," she says. "I could tell he wasn't just drunk and he wasn't just high."
Was a psychiatric illness beginning? Maybe, but it's difficult to tell, because Loughner had by then used a lot of drugs — not just pot but also hallucinogens like acid, according to Smith. It was at about this time that Loughner did something odd: he worked out for months so he could join the Army. Yet after traveling to the military processing station in Phoenix, he told an Army official that he smoked marijuana excessively — which meant he would never be accepted. The weird part: he actually passed a drug test that day, so he had not been using for at least a couple of weeks. (See photos of the world of Jared Lee Loughner.)
Loughner's behavior became increasingly erratic after the Army incident. Friends say he would occasionally speak in random strings of words. He had run-ins with police over drugs and his vandalization of a street sign. He became paranoid that the government was trying to control him — or everyone. He couldn't keep jobs at Quiznos and an animal shelter because he wouldn't — or could no longer — follow instructions.
When classes began at Pima Community College last year, Loughner's behavior frightened fellow students from Day One. "He had this hysterical kind of laugh, laughing to himself," says Benjamin McGahee, his math professor. He would say nonsensical things about "denying math." Says McGahee: "One lady in the back of the classroom said she was scared for her life, literally."(Comment on this story.)
Such Stuff as Dreams
It seems clear that Loughner was developing a mental illness, but which one? Many signs point to one of the psychotic disorders — delusional disorder, say, or schizophrenia, for which the average age of onset is roughly 20, about when Loughner started showing symptoms. The Diagnostic and Statistical Manual of Mental Disorders includes "substance-induced psychotic disorder," which is also a possibility in Loughner's case. (See six warning signs of whether someone is mentally ill.)
By several accounts, Loughner had become fascinated with lucid dreaming, a dream state you can enter when you're half asleep. You are aware while you're in that state that you're dreaming. Loughner's interest in his lucid dreams is significant, because last year the European Science Foundation reported that lucid dreaming "creates distinct patterns of electrical activity in the brain that have similarities to the patterns made by psychotic conditions." Loughner's drug use could have kept him from falling into deep sleep and encouraged lucid dreaming. The European group said paranoid delusions can occur when lucid dreams are replayed repeatedly after the subject wakes up. Loughner was replaying his lucid dreams in an extensive dream journal, according to his friend Bryce Tierney, who spoke with Mother Jones magazine.
See TIME's complete coverage of the Tucson shooting.
See pictures of messages for the Tucson victims.
But snapshots of his life are accumulating from acquaintances and his few friends. (His parents issued a short statement of apology, but they are said to be too distraught to speak about their son.) These snapshots depict a quiet, normal boy who had grown into a man descending steadily into serious mental illness. A partisan, highly nonscientific debate has erupted over whether extreme right-wing rhetoric could have inflamed whatever illness he may have and caused him to target Democratic Representative Gabrielle Giffords. We don't know the answer, but psychological research suggests that political rhetoric could never be the single cause that leads a person with complex mental problems to commit violence. (See pictures from a grieving Tucson.)
Case History
Pinpointing the precise moment a mental illness takes root is guesswork at best. As a young man, Loughner seemed ordinary enough — occasionally withdrawn, as all teens can be, and a little nerdy. He loved music and played the sax well. A classmate who had known him since elementary school, Ashley Buysman, says that when she heard the charges against him, "it just blew my mind."
But a darkness began massing around Loughner sometime after he dropped out of Mountain View High School in Tucson, Ariz., before his senior year. He started drinking a lot, according to Kylie Smith, who had known him since preschool. She lost contact with him between 2006 and 2008 and was stunned by how much he had changed. "He seemed out of it, like he was somewhere else," she says. "I could tell he wasn't just drunk and he wasn't just high."
Was a psychiatric illness beginning? Maybe, but it's difficult to tell, because Loughner had by then used a lot of drugs — not just pot but also hallucinogens like acid, according to Smith. It was at about this time that Loughner did something odd: he worked out for months so he could join the Army. Yet after traveling to the military processing station in Phoenix, he told an Army official that he smoked marijuana excessively — which meant he would never be accepted. The weird part: he actually passed a drug test that day, so he had not been using for at least a couple of weeks. (See photos of the world of Jared Lee Loughner.)
Loughner's behavior became increasingly erratic after the Army incident. Friends say he would occasionally speak in random strings of words. He had run-ins with police over drugs and his vandalization of a street sign. He became paranoid that the government was trying to control him — or everyone. He couldn't keep jobs at Quiznos and an animal shelter because he wouldn't — or could no longer — follow instructions.
When classes began at Pima Community College last year, Loughner's behavior frightened fellow students from Day One. "He had this hysterical kind of laugh, laughing to himself," says Benjamin McGahee, his math professor. He would say nonsensical things about "denying math." Says McGahee: "One lady in the back of the classroom said she was scared for her life, literally."(Comment on this story.)
Such Stuff as Dreams
It seems clear that Loughner was developing a mental illness, but which one? Many signs point to one of the psychotic disorders — delusional disorder, say, or schizophrenia, for which the average age of onset is roughly 20, about when Loughner started showing symptoms. The Diagnostic and Statistical Manual of Mental Disorders includes "substance-induced psychotic disorder," which is also a possibility in Loughner's case. (See six warning signs of whether someone is mentally ill.)
By several accounts, Loughner had become fascinated with lucid dreaming, a dream state you can enter when you're half asleep. You are aware while you're in that state that you're dreaming. Loughner's interest in his lucid dreams is significant, because last year the European Science Foundation reported that lucid dreaming "creates distinct patterns of electrical activity in the brain that have similarities to the patterns made by psychotic conditions." Loughner's drug use could have kept him from falling into deep sleep and encouraged lucid dreaming. The European group said paranoid delusions can occur when lucid dreams are replayed repeatedly after the subject wakes up. Loughner was replaying his lucid dreams in an extensive dream journal, according to his friend Bryce Tierney, who spoke with Mother Jones magazine.
See TIME's complete coverage of the Tucson shooting.
See pictures of messages for the Tucson victims.
The Health IT Paradox: Why More Data Doesn't Always Mean Better Care
Recently, while I was working an overnight shift in the emergency department, two paramedics wheeled an elderly woman into the busy ER. She was clearly very ill: her eyes were sunken and her mouth was parched, she was slumped over and unable to do much more than moan. The paramedics told me that her family members, who had stayed home (not uncommon!), wanted to make sure we knew that she wasn't usually "like this" and that she had recently been hospitalized at a different facility where many tests and "other stuff" had been done. Unfortunately, all her records were locked up at the other hospital's medical-record room, which was closed in the middle of the night.
We had to start from scratch. We ordered a CAT scan of her brain to look for stroke, put a catheter in her bladder and gave her a chest X-ray to look for infection, and applied a rectal exam to look for bleeding. We may have ended up doing all of this anyway, but having more information about her recent hospitalization would clearly have allowed us to be more efficient and directed in her care. My colleague, another doctor, turned to me and said, "I cannot wait until HIT [industry shorthand for 'health-information technology'] makes this problem goes away." (See the top 10 medical breakthroughs of 2010.)
The "problem," of course, is that medical errors and excess costs increase when health information isn't portable or easily accessible. The conventional wisdom is that electronic medical records, electronic prescriptions and electronic order-entry systems save costs and lives. Since 2009, the federal government has invested over $20 billion into improving HIT. And this month, the federal government will start doling out dollars to doctors' offices and hospitals to encourage them to adopt electronic health records. On its face, this makes absolute sense — who, after all, would argue that more information isn't essential to improved care at lower cost? During the last presidential campaign, both Senators John McCain and Barack Obama called for HIT enhancements as key to fixing health care. (See 10 players in health care reform.)
But an overzealous push toward HIT can also lead to unintended consequences. In Pittsburgh, a study showed that the rollout of an electronic system for doctors' orders was associated with increased odds of infant deaths in an intensive-care unit. And a study conducted in Philadelphia demonstrated that computerized physician-order-entry systems facilitated medication-prescribing errors. What was going on? In Pittsburgh, medications were given too frequently because the computer used standardized dosing times to order medication (as opposed to using the time of the first dose to calculate time to the next dose). In the Philadelphia study, many of the problems arose from what are known as human-machine interface flaws. For example, doctors would sometimes assume that a display of standard doses were suggested doses specific to the patient being treated at that moment (not the same thing!). Or doctors sometimes picked the wrong medication or dose because they didn't know that all of their options did not fit on a single computer screen and that they could click through to a second screen for more choices.
Remember the giant whiteboard used to keep track of patients and their room numbers on the TV show ER? The whiteboard is a great example of a low-tech device that can easily be customized to maximize patient care. A colleague of mine who lectures widely on patient safety shows a picture of an ER whiteboard where nurses put teddy-bear magnets next to the names of children in order to distinguish them from adult patients. Similarly, social scientists have observed how doctors and nurses gather around the whiteboard to discuss patients and their care in an effective manner. But with efforts to maximize patient privacy and go high tech, the whiteboard has largely been replaced by computerized electronic tracking systems which often reside on small monitors and frequently have no way to display information as efficiently and elegantly as a teddy-bear magnet. (Watch TIME's video "Uninsured Again.")
Of course, some of these problems will diminish as HIT systems themselves become better designed and more flexible (where I work, the computerized tracking system is customizable and has a big screen display so that doctors and nurses can easily gather around it). And implementation problems (when people are asked to do things differently than the way they have always done it, they mess it up at first) will get better as everyone gets used to using HIT. But there are some insidious factors that come with electronic health information that can be difficult to identify and measure, especially when the human element is removed from health care by technology. Here is an example: not that long ago, if I ordered an X-ray on a patient, I had to walk into the radiology-reading area to look at it. Often there would be a radiologist sitting there in the dark room; we would talk about the patient in a way that would often lead to closer examination of one part of the X-ray. Sometimes this conversation would lead to a cooperative reconsideration of the findings. But now, unless I have a specific question or concern, I don't have to go back to the radiology reading room — HIT allows me to look at both the X-ray and the radiologist report almost instantly on my desktop computer in the ER. Sure, it is efficient and helps me see more patients and spend more time on other emergency tasks. But the result, I worry, is that I may be more likely to miss something important. Experts in the field of medical informatics attribute this error to the loss of feedback. In other words, communication should be more than just transferring information — it needs to be about getting people to act in the right way. In my X-ray case, HIT leads to standardized and reliable information exchange but unintentionally takes away the conversation, and the opportunity that conversation presents to improve patient care. (See how to prevent illness at any age.)
So should we scale back our efforts to expand and improve HIT? Absolutely not. My elderly patient who arrived by ambulance (who, it turned out, had a colon and blood-stream infection) and the many patients like her, need to have their medical information made available in a comprehensive, reliable and efficient way. But we also need to be aware that electronic health information is not a panacea. The federal government has issued strict criteria for electronic health records called "meaningful use" which will seek to expand access to information and minimize disparities in care. But explicit plans to minimize unintended consequences of health information technology appear to be limited. HIT can change the way we deliver health care in ways that may be both hard to monitor and sometimes worse for our patients. And it is essential to keep an eye out for these influences. (Comment on this story.)
Dr. Meisel is a Robert Wood Johnson Foundation Clinical Scholar and an emergency physician at the University of Pennsylvania. The Medical Insider, his column for TIME.com appears every Wednesday.
Clarification: The original version of this story has been updated to make clear that the federal government does not yet have many explicit plans to minimize unintended adverse consequences of health information technology.
We had to start from scratch. We ordered a CAT scan of her brain to look for stroke, put a catheter in her bladder and gave her a chest X-ray to look for infection, and applied a rectal exam to look for bleeding. We may have ended up doing all of this anyway, but having more information about her recent hospitalization would clearly have allowed us to be more efficient and directed in her care. My colleague, another doctor, turned to me and said, "I cannot wait until HIT [industry shorthand for 'health-information technology'] makes this problem goes away." (See the top 10 medical breakthroughs of 2010.)
The "problem," of course, is that medical errors and excess costs increase when health information isn't portable or easily accessible. The conventional wisdom is that electronic medical records, electronic prescriptions and electronic order-entry systems save costs and lives. Since 2009, the federal government has invested over $20 billion into improving HIT. And this month, the federal government will start doling out dollars to doctors' offices and hospitals to encourage them to adopt electronic health records. On its face, this makes absolute sense — who, after all, would argue that more information isn't essential to improved care at lower cost? During the last presidential campaign, both Senators John McCain and Barack Obama called for HIT enhancements as key to fixing health care. (See 10 players in health care reform.)
But an overzealous push toward HIT can also lead to unintended consequences. In Pittsburgh, a study showed that the rollout of an electronic system for doctors' orders was associated with increased odds of infant deaths in an intensive-care unit. And a study conducted in Philadelphia demonstrated that computerized physician-order-entry systems facilitated medication-prescribing errors. What was going on? In Pittsburgh, medications were given too frequently because the computer used standardized dosing times to order medication (as opposed to using the time of the first dose to calculate time to the next dose). In the Philadelphia study, many of the problems arose from what are known as human-machine interface flaws. For example, doctors would sometimes assume that a display of standard doses were suggested doses specific to the patient being treated at that moment (not the same thing!). Or doctors sometimes picked the wrong medication or dose because they didn't know that all of their options did not fit on a single computer screen and that they could click through to a second screen for more choices.
Remember the giant whiteboard used to keep track of patients and their room numbers on the TV show ER? The whiteboard is a great example of a low-tech device that can easily be customized to maximize patient care. A colleague of mine who lectures widely on patient safety shows a picture of an ER whiteboard where nurses put teddy-bear magnets next to the names of children in order to distinguish them from adult patients. Similarly, social scientists have observed how doctors and nurses gather around the whiteboard to discuss patients and their care in an effective manner. But with efforts to maximize patient privacy and go high tech, the whiteboard has largely been replaced by computerized electronic tracking systems which often reside on small monitors and frequently have no way to display information as efficiently and elegantly as a teddy-bear magnet. (Watch TIME's video "Uninsured Again.")
Of course, some of these problems will diminish as HIT systems themselves become better designed and more flexible (where I work, the computerized tracking system is customizable and has a big screen display so that doctors and nurses can easily gather around it). And implementation problems (when people are asked to do things differently than the way they have always done it, they mess it up at first) will get better as everyone gets used to using HIT. But there are some insidious factors that come with electronic health information that can be difficult to identify and measure, especially when the human element is removed from health care by technology. Here is an example: not that long ago, if I ordered an X-ray on a patient, I had to walk into the radiology-reading area to look at it. Often there would be a radiologist sitting there in the dark room; we would talk about the patient in a way that would often lead to closer examination of one part of the X-ray. Sometimes this conversation would lead to a cooperative reconsideration of the findings. But now, unless I have a specific question or concern, I don't have to go back to the radiology reading room — HIT allows me to look at both the X-ray and the radiologist report almost instantly on my desktop computer in the ER. Sure, it is efficient and helps me see more patients and spend more time on other emergency tasks. But the result, I worry, is that I may be more likely to miss something important. Experts in the field of medical informatics attribute this error to the loss of feedback. In other words, communication should be more than just transferring information — it needs to be about getting people to act in the right way. In my X-ray case, HIT leads to standardized and reliable information exchange but unintentionally takes away the conversation, and the opportunity that conversation presents to improve patient care. (See how to prevent illness at any age.)
So should we scale back our efforts to expand and improve HIT? Absolutely not. My elderly patient who arrived by ambulance (who, it turned out, had a colon and blood-stream infection) and the many patients like her, need to have their medical information made available in a comprehensive, reliable and efficient way. But we also need to be aware that electronic health information is not a panacea. The federal government has issued strict criteria for electronic health records called "meaningful use" which will seek to expand access to information and minimize disparities in care. But explicit plans to minimize unintended consequences of health information technology appear to be limited. HIT can change the way we deliver health care in ways that may be both hard to monitor and sometimes worse for our patients. And it is essential to keep an eye out for these influences. (Comment on this story.)
Dr. Meisel is a Robert Wood Johnson Foundation Clinical Scholar and an emergency physician at the University of Pennsylvania. The Medical Insider, his column for TIME.com appears every Wednesday.
Clarification: The original version of this story has been updated to make clear that the federal government does not yet have many explicit plans to minimize unintended adverse consequences of health information technology.
10 Questions for Jimmy Wales
How did Wikipedia start? —Anushka Gole, MUMBAI
Wikipedia was my second attempt at creating a free encyclopedia for everyone. The first attempt was called Nupedia, which was a failure. The model we used to try to create Nupedia was very top-down, very academic and not very much fun for the volunteers. I launched the Wiki in 2001, and it just grew and grew and grew.
Why did you decide to allow users to edit Wikipedia? —Lewis Boone IV, KANSAS CITY, KANS.
The main reason we allow everyone to edit is quality. It's about allowing for an open, democratic dialogue to get the best possible entry that we can. The great beauty of the Internet is that it allows for a huge range of people to participate constructively. (See pictures of Jimmy Wales.)
Is the traditional encyclopedia dead? —Peter Heidener, AARHUS, DENMARK
I'm not sure if it's dead, but it certainly is ailing--although it was ailing long before we came along. Britannica took a severe hit from Microsoft Encarta, which dramatically reduced the cost of the encyclopedia.
Does Wikipedia as it is now fulfill the expectations you had when you started it? —Sharon Lecluyse, GHENT, BELGIUM
I remember, in the early days of Wikipedia, looking at a list of the top 100 websites and seeing an encyclopedia-reference site ranked around No. 50. I thought, If we do a really good job, maybe we can make it into the top 100. Now we're the fifth most popular website in the world, with over 400 million people visiting every month. It's much bigger than I expected. (Watch the interview with Jimmy Wales.)
Is Wikipedia financially sustainable? —Joonpyo Sohn, SEOUL
We think it is. We exist through the donations of the general public. The vast majority of [them] come from our annual giving campaign. That gives us enough money for another year. Is it sustainable in the long term? I think it is, but time will tell.
Would you run ads if the need occurred? Or would you shut down Wikipedia? —James Lillin, HAMBURG, N.Y.
We're opposed to having advertising on Wikipedia, but we will do what it takes to keep Wikipedia alive. In the event that the public was no longer willing to support us to the degree that we needed, we would first look at cost-cutting measures. We would eventually have to look at putting some ads in some obscure part of the site. [But] it's not something that we even think is likely to happen.
When is censorship of entries acceptable? —Carlos Castellar, MIAMI
We need to make a very careful distinction between censorship and editorial judgment. Censorship is forbidding the publication of certain knowledge. Editorial judgment [means asking], Are these facts relevant? Are they verifiable? Every entry has to be subject to thoughtful editorial judgment. But it's never the case that we should accept censorship. (See the 50 best websites of 2010.)
In what ways can the accuracy and integrity of information on Wikipedia be improved? —Jawad Farooq, LONDON
By improving the software that's available to the community to monitor Wikipedia, the degree to which they can control things, diversifying the contributor base. We're very, very good on topics that are of interest to the late-20s, early-30s tech-geek male because that's our core contributor group. We need more participation in topics outside that range.
Do you worry that WikiLeaks is giving Wikipedia a bad name? —Dennis Pope, RIVERSIDE, CALIF.
We have absolutely nothing to do with WikiLeaks. We shouldn't get credit for it, and we shouldn't get criticized for it. I've had a couple of cringing moments where I see some head of state who makes the error, and I'm like, Oh, come on.
What lie would you allow on your Wikipedia page? —Jeremy Parilla, TAGUIG CITY, PHILIPPINES
[Laughs.] It should say, "He always has a clever response to every question." Absolutely a lie.
Wikipedia was my second attempt at creating a free encyclopedia for everyone. The first attempt was called Nupedia, which was a failure. The model we used to try to create Nupedia was very top-down, very academic and not very much fun for the volunteers. I launched the Wiki in 2001, and it just grew and grew and grew.
Why did you decide to allow users to edit Wikipedia? —Lewis Boone IV, KANSAS CITY, KANS.
The main reason we allow everyone to edit is quality. It's about allowing for an open, democratic dialogue to get the best possible entry that we can. The great beauty of the Internet is that it allows for a huge range of people to participate constructively. (See pictures of Jimmy Wales.)
Is the traditional encyclopedia dead? —Peter Heidener, AARHUS, DENMARK
I'm not sure if it's dead, but it certainly is ailing--although it was ailing long before we came along. Britannica took a severe hit from Microsoft Encarta, which dramatically reduced the cost of the encyclopedia.
Does Wikipedia as it is now fulfill the expectations you had when you started it? —Sharon Lecluyse, GHENT, BELGIUM
I remember, in the early days of Wikipedia, looking at a list of the top 100 websites and seeing an encyclopedia-reference site ranked around No. 50. I thought, If we do a really good job, maybe we can make it into the top 100. Now we're the fifth most popular website in the world, with over 400 million people visiting every month. It's much bigger than I expected. (Watch the interview with Jimmy Wales.)
Is Wikipedia financially sustainable? —Joonpyo Sohn, SEOUL
We think it is. We exist through the donations of the general public. The vast majority of [them] come from our annual giving campaign. That gives us enough money for another year. Is it sustainable in the long term? I think it is, but time will tell.
Would you run ads if the need occurred? Or would you shut down Wikipedia? —James Lillin, HAMBURG, N.Y.
We're opposed to having advertising on Wikipedia, but we will do what it takes to keep Wikipedia alive. In the event that the public was no longer willing to support us to the degree that we needed, we would first look at cost-cutting measures. We would eventually have to look at putting some ads in some obscure part of the site. [But] it's not something that we even think is likely to happen.
When is censorship of entries acceptable? —Carlos Castellar, MIAMI
We need to make a very careful distinction between censorship and editorial judgment. Censorship is forbidding the publication of certain knowledge. Editorial judgment [means asking], Are these facts relevant? Are they verifiable? Every entry has to be subject to thoughtful editorial judgment. But it's never the case that we should accept censorship. (See the 50 best websites of 2010.)
In what ways can the accuracy and integrity of information on Wikipedia be improved? —Jawad Farooq, LONDON
By improving the software that's available to the community to monitor Wikipedia, the degree to which they can control things, diversifying the contributor base. We're very, very good on topics that are of interest to the late-20s, early-30s tech-geek male because that's our core contributor group. We need more participation in topics outside that range.
Do you worry that WikiLeaks is giving Wikipedia a bad name? —Dennis Pope, RIVERSIDE, CALIF.
We have absolutely nothing to do with WikiLeaks. We shouldn't get credit for it, and we shouldn't get criticized for it. I've had a couple of cringing moments where I see some head of state who makes the error, and I'm like, Oh, come on.
What lie would you allow on your Wikipedia page? —Jeremy Parilla, TAGUIG CITY, PHILIPPINES
[Laughs.] It should say, "He always has a clever response to every question." Absolutely a lie.
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